Inmagic CS/WebPublisher PRO found 2943 records

Your search found 2943 record(s).
New Basic Search | New Advanced Search | POPLINE Document Delivery Policy

Title: Expanding access to injectable contraception.
Author: Family Health International [FHI]
Source: [Unpublished] [2009]. 12 p.
Abstract: A number of technological developments can make injections safer for administration, whether by health personnel, trained community workers or the women themselves: sub-cutaneous injections, which have less complications than intra-muscular injections; non-reusable disposable syringes Distribution by community health workers needs special attention to: the possibility that a woman is already pregnant (or seeking an abortion by using an injectable); the screening of women with pre-existing conditions or on medications; the need for counselling for side-effects (in particular: vaginal bleeding irregularities, amenorrhea, weight gain, delay in return to fertility); the safety of injections to the woman and to the health worker; the possible confusion between different injectables --provided by public and private sectors. To complement pre-service and in-service training, a number of job aids are available to support community workers providing injectables: medical eligibility criteria wheel to screen for eligibility; pregnancy checklist; simplified material for the management of side-effects (bleeding, amenorrhea, weight changes, etc). (Excerpt)
Language: English
Keywords:
GLOBAL | TABLES AND CHARTS | INJECTABLES | DEPO-PROVERA | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | PROGRAM ACCESSIBILITY | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTIVE SAFETY | MATERNAL MORTALITY | CAUSES OF DEATH | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Usage | Program Evaluation | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Safety | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 331838

Title: Use of and unmet need for injectable contraception.
Author: Family Health International [FHI]
Source: [Unpublished] 2009 Jun 8. 12 p.
Abstract: Understanding trends in contraceptive use and unmet need for family planning is critical to creating policies which respond to current gaps in service delivery and address future needs for services to meet existing and unmet demand. Creating non clinic-based mechanisms to deliver services has the potential to expand access to underserved populations and reduce pressure on weak health systems. This document examines patterns of the current use of and unmet demand for injectable services. Trends in use of clinic and non clinic-based services for injectables, differentials in injectable use by place of residence, and potential negative consequences of increased use of injectables are explored. Information described in this paper is intended to inform the Technical Consultation on Expanding Access to Injectable Contraception. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | TECHNICAL REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | INJECTABLES | CONTRACEPTIVE USAGE | NEEDS | COMMUNITY-BASED DISTRIBUTION | CLINICAL DISTRIBUTION | PHARMACIES | CONTRACEPTIVE DISTRIBUTION | GEOGRAPHIC FACTORS | CONTRACEPTION CONTINUATION | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Economic Factors | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Health Facilities | Delivery of Health Care | Health
Document Number: 331836

Title: Community-based distribution of injectable contraceptives. Approaches that work.
Author: Futures Group International. Health Policy Initiative
Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 Apr. [1] p.
Abstract: Contraceptive prevalence rates in many sub-Saharan African countries surged in the mid-1990s. Much of this increase can be attributed to additional resources devoted to family planning (FP) programs and the uptake of specific methods, including injectable contraceptives. For example, use of injectables in Malawi grew from 2 percent in 1992 to 18 percent in 2004. Surveys in many African countries have found that women prefer injectable contraceptives; in some cases, preference for injectables is 2-1 over oral contraceptives and other methods. In recent years, however, these same countries have experienced a stagnation or decline in overall contraceptive prevalence. Particularly in rural areas, modern contraceptives are often scarce, and few trained professionals are available to provide FP services. One way to increase access to and use of family planning is to promote community-based distribution (CBD) of injectables. Countries struggling with stagnating contraceptive prevalence can begin to alterthis trend by training and empowering community-based workers to provide injectable contraceptives.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | CONTRACEPTIVE PREVALENCE | INJECTABLES | ORAL CONTRACEPTIVES | COMMUNITY-BASED DISTRIBUTION | PRIVATE SECTOR | HEALTH SERVICES | Contraceptive Usage | Contraception | Family Planning | Contraceptive Methods | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Macroeconomic Factors | Economic Factors | Delivery of Health Care | Health
Document Number: 331532

Title: Expanding access to injectable contraceptives.
Author: United States. Agency for International Development [USAID]
Source: [Washington, D.C.], USAID, [2009]. [2] p.
Abstract: A technical consultation, co-sponsored by the World Health Organization (WHO), USAID, and Family Health International (FHI), was held June 15-17, 2009, at the WHO in Geneva to review the evidence and programmatic experience for community-based provision of injectable contraceptives. Thirty technical and program experts from countries and organizations reviewed the scientific evidence and experiences from programs that provided injectable contraceptives through community-based health workers (CHWs). This evidence and programmatic experience came from Africa, Asia, and Latin America and focused on depotmedroxyprogesterone acetate (DMPA). The evidence consistently showed that given appropriate training, CHWs can screen clients effectively, provide DMPA injections safely, and counsel on side effects appropriately, demonstrating competence equivalent to higher level facility-based providers of DMPA. Continuation of use of DMPA by clients of CHWs was as long as those of clients receiving injections at clinics. In addition, the vast majority of clients expressed satisfaction with CHW provision of DMPA. The Consultation concluded that sufficient evidence existed for national policies to support the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives, especially DMPA. Provision of DMPA by CHWs will expand choice for underserved populations and contribute to reducing the unmet need for family planning. Operational guidelines for family planning should therefore reflect that appropriately trained CHWs can safely initiate use of DMPA and provide reinjection. (Excerpt)
Language: English
Keywords:
GLOBAL | SUMMARY REPORT | CONFERENCES AND CONGRESSES | COMMUNITY WORKERS | WHO | INJECTABLES | DEPO-PROVERA | SAFETY | CONTRACEPTION CONTINUATION | TRAINING ACTIVITIES | COUNSELING | FAMILY PLANNING POLICY | Health Personnel | Delivery of Health Care | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Public Health | Contraceptive Usage | Training Programs | Education | Clinic Activities | Program Activities | Programs | Organization and Administration | Population Policy | Social Policy | Policy
Document Number: 331839

Title: Community-based health workers can safely and effectively administer injectable contraceptives: Conclusions from a technical consultation.
Author: World Health Organization [WHO]; United States. Agency for International Development [USAID]; Family Health International [FHI]
Source: Research Triangle Park, North Carolina, FHI, 2009. 4 p.
Abstract: In June 2009, a technical consultation held at the World Health Organization (WHO) in Geneva concluded that evidence supports the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives. The group of 30 technical and programme experts reviewed scientific and programmatic experience, which largely focused on the progestin-only injectable, depot-medroxyprogesterone acetate (DMPA). The experts found that community-based provision of progestin-only injectable contraceptives by appropriately trained community health workers (CHWs) is safe, effective, and acceptable. Such services should be part of a family planning programme offering a range of contraceptive methods. (Excerpt)
Language: English
Keywords:
GLOBAL | CONFERENCES AND CONGRESSES | COMMUNITY WORKERS | WHO | INJECTABLES | DEPO-PROVERA | NEEDS | SAFETY | CONTRACEPTION CONTINUATION | TRAINING ACTIVITIES | MONITORING | FAMILY PLANNING POLICY | Health Personnel | Delivery of Health Care | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Economic Factors | Public Health | Contraceptive Usage | Training Programs | Education | Evaluation | Population Policy | Social Policy | Policy
Document Number: 331834

Title: WHO / USAID / FHI Technical Consultation: Expanding Access to Injectable Contraception, 15-17 June 2009, Room M405, WHO, Geneva.
Author: World Health Organization [WHO]; United States. Agency for International Development [USAID]; Family Health International [FHI]
Source: [Unpublished] 2009. 5 p.
Abstract: The agenda for the consultation is presented. The objectives of the consultation were: To review systematically the evidence and programmatic experience on interventions designed to expand access to / provision of contraceptive injectables, focusing on non clinic-based services and programs; To reach conclusions on issues: (a) for which evidence is consistent and strong; (b) for which evidence is mixed; and (c) for which evidence is marginal or entirely lacking and, thus requires additional research; To document discussions and conclusions of the Consultation, including policy and program implications, and to disseminate these widely.
Language: English
Keywords:
GLOBAL | TABLES AND CHARTS | CONFERENCES AND CONGRESSES | WHO | USAID | INJECTABLES | CONTRACEPTIVE AVAILABILITY | INTERVENTIONS | NEEDS | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTION CONTINUATION | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Government Agencies | Contraceptive Methods | Contraception | Family Planning | Programs | Organization and Administration | Economic Factors | Nonclinical Distribution | Distributional Activities | Program Activities | Contraceptive Usage
Document Number: 331853

Title: Hormonal methods of contraception for youth. More effective strategies are needed to improve access and encourage consistent use.
Author: Aradhya K; Lebetkin E
Source: Research Triangle Park, North Carolina, Family Health International [FHI], Interagency Youth Working Group, 2009 May. [4] p. (YouthLens on Reproductive Health and HIV / AIDS No. 30)
Abstract: Youth, defined here as people ages 10 to 24 years old, need better access to contraception. The decreasing age of menarche and increasing age of marriage have created an ever-widening window of time for premarital sexual intercourse and pregnancies. Hormonal methods of contraception -- including oral contraceptive pills, injectables, and implants -- are among the most effective methods of preventing unintended pregnancies. They are generally well known among youth and, as an alternative to condoms, allow a young woman to control her risk of pregnancy. (Excerpts)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | YOUTH | ORAL CONTRACEPTIVES | INJECTABLES | CONTRACEPTIVE IMPLANTS | PREGNANCY, UNPLANNED | PREVENTION AND CONTROL | STIGMA | HEALTH FACILITIES | PROGRAM ACCESSIBILITY | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Age Factors | Population Characteristics | Contraceptive Methods | Contraception | Family Planning | Reproductive Behavior | Fertility | Diseases | Social Problems | Sociocultural Factors | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration
Document Number: 331499

Subscription may be needed for full text

Title: Experience with side effects among users of injectables, the IUD, and oral contraceptive pills in four urban areas of Honduras.
Author: Barden-O'Fallon J; Speizer I; Rodriguez F; Calix J
Source: Health Care For Women International. 2009 Jun;30(6):475-83.
Abstract: Contraceptive side effects are often the most commonly reported reason for method discontinuation, particularly of modern methods. We use data from eight focus groups and 800 exit interviews to examine women's experiences with contraceptive side effects in four urban areas of Honduras. Ease of treatment and differences in motivation to avoid pregnancy are suggested explanations for why side effects cause some women to continue and others to discontinue. Although side effects are a common reason for discontinuation in this population, less than half of the surveyed women were informed about potential side effects by a health worker on the day of the interview.
Language: English
Keywords:
HONDURAS | RESEARCH REPORT | FOCUS GROUPS | URBAN AREAS | HEALTH PERSONNEL | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | INJECTABLES | IUD SIDE EFFECTS | PROGRAM ACCEPTABILITY | Developing Countries | Central America | Latin America | Americas | Data Collection | Research Methodology | Geographic Factors | Population | Delivery of Health Care | Health | Demographic Factors | Contraceptive Safety | Safety | Public Health | Contraceptive Methods | Contraception | Family Planning | IUD | Program Evaluation | Programs | Organization and Administration
Document Number: 341018

Peer Reviewed

Title: Bone mineral density in young women aged 19-24 after 4-5 years of exclusive and mixed use of hormonal contraception.
Author: Beksinska ME; Kleinschmidt I; Smit JA; Farley TM; Rees HV
Source: Contraception. 2009 Aug;80(2):128-32.
Abstract: BACKGROUND: Use of depot-medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and low-dose combined oral contraceptives (COCs) has been associated with loss of bone mineral density (BMD) in adolescents. However, the effect of using a combination of these methods over time in this age group is limited. The aim of this cross-sectional study was to investigate BMD in young women (aged 19-24 years) with a history of mixed hormonal contraceptive use. STUDY DESIGN: BMD was measured at the spine, hip and femoral neck using dual X-ray absorptiometry. Women were classified into three groups: (1) injectable users (DMPA, NET-EN or both) (n=40), (2) mixed COC and injectable users (n=13) and (3) non-user control (n=41). RESULTS: Women in the injectables-only user group were found to have lower BMDs compared to the non-user group at all three sites, and there was evidence of a difference in BMD between these two groups at the spine after adjusting for body mass index (p=.042), hip (p=.025) and femoral neck (p=.023). The mixed COC/injectable user group BMD values were lower than those for controls; however, there was no evidence of a significant difference between this group and the non-user group at any of the three sites. CONCLUSION: This study suggests that BMD is lower in long-term injectable users but not when women have mixed injectable and COC use.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CONTROL GROUPS | WOMEN | YOUTH | INJECTABLES | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE AGENTS, SIDE EFFECTS | SKELETAL EFFECTS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Age Factors | Population Characteristics | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Oral Contraceptives | Physiology | Biology
Document Number: 342307

10.
Title: Contraception for women with epilepsy.
Author: Burakgazi E; Harden C; Kelly JJ
Source: Reviews in Neurological Diseases. 2009 Spring;6(2):E62-7.
Abstract: The choice of a contraceptive drug can be challenging for women with epilepsy due to possible interactions between antiepileptic drugs (AEDs) and hormonal contraception. Enzyme-inducing AEDs can cause hormonal contraception to fail and can increase the risk of teratogenicity. Higher doses of oral contraceptives can overcome pharmacologic failure but may create additional risks. The effects of reproductive hormones on individual AEDs have recently been clarified, providing helpful guidelines for physicians and patients. Studies show that lamotrigine has a significantly increased clearance (> 50%) when used with combined oral contraceptives, which results in an increased seizure frequency in most patients. Useful alternatives to oral contraceptives include depot injections and intrauterine devices. Subdermal implants may increase the risk of pregnancy in women with epilepsy on enzyme-inducing AEDs. Depot medroxyprogesterone acetate is effective but can increase side effects. Intrauterine devices arean alternative to pharmacologic approaches because they lack drug-drug interactions and side effects.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | ORAL CONTRACEPTIVES | IUD | INJECTABLES | NEUROLOGIC EFFECTS | DRUGS | DRUG INTERACTIONS | TREATMENT | SIDE EFFECTS | Developed Countries | North America | Americas | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341913

11.

Title: Progestogen-only contraceptives and the risk of stroke: a meta-analysis.
Author: Chakhtoura Z; Canonico M; Gompel A; Thalabard JC; Scarabin PY; Plu-Bureau G
Source: Stroke; A Journal of Cerebral Circulation. 2009 Apr;40(4):1059-62.
Abstract: BACKGROUND AND PURPOSE: The association between combined oral contraceptives (OC) use and increased risk of stroke has been reported. While progestogen-only contraceptives (POC) are commonly used worldwide, their impact on cardiovascular disease remains unclear. METHODS: A meta-analysis based on EMBASE and MEDLINE referenced literature corresponding to OCs marketed since 1960 was carried out. Eligible articles assessing the risk of stroke in relation to OC or POC were reviewed, and relevant studies were extracted. All types of POC and routes of administration were taken into account in the meta-analysis. RESULTS: Six case-control studies were identified. The combined odd ratio (OR) showed no increase in the risk of stroke among POC users (OR=0.96; 95% confidence interval: 0.70 to 1.31). This result was similar according to the route of administration (either implant or injectable or oral POC). CONCLUSIONS: Data from observational studies show that POC use is not associated with an increased risk of stroke. However, these results are based on limited data. Further investigations are needed in women with risk factors of stroke.
Language: English
Keywords:
FRANCE | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | COMPARATIVE STUDIES | WOMEN | PREVALENCE | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, PROGESTIN | RISK ASSESSMENT | CEREBROVASCULAR EFFECTS | CONTRACEPTIVE IMPLANTS | INJECTABLES | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | Measurement | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Evaluation | Physiology | Biology | Contraceptive Methods
Document Number: 331085

13.

Peer Reviewed

Title: Cost savings from the provision of specific methods of contraception in a publicly funded program.
Author: Foster DG; Rostovtseva DP; Brindis CD; Biggs MA; Hulett D; Darney PD
Source: American Journal of Public Health. 2009 Mar;99(3):446-51.
Abstract: OBJECTIVES: We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955,000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. METHODS: We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. RESULTS: More than half of the 178,000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. CONCLUSIONS: All contraceptive methods were cost-effective-they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods.
Language: English
Keywords:
UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | COST EFFECTIVENESS | CONTRACEPTIVE METHODS | ORAL CONTRACEPTIVES | INJECTABLES | BARRIER METHODS | IUD | CONTRACEPTIVE IMPLANTS | Developed Countries | North America | Americas | Evaluation Indexes | Quantitative Evaluation | Evaluation | Contraception | Family Planning
Document Number: 330488

14.

Title: [Descriptive study on contraceptive requirements for clinical trials in Spain. Do we need a debate?] Estudio descriptivo de las recomendaciones anticonceptivas en los ensayos
Author: Gastaminza Lasarte G; Algorta Pineda J
Source: Medicina Clinica. 2009 Jan 24;132(2):70-4.
Abstract: Among the measures that seek to avoid the toxic effects on reproduction (teratogenic, embryotoxic, fetotoxic or otherwise) include the obligation to conduct preclinical tests to investigate this aspect in different animal species before marketing a new drug, although its application in time differs Europe-European Medicines Agency (EMEA) and US-Food and Drug Administration (FDA). In Europe requires that prior to including women in phase I of clinical trials have been completed preclinical studies on embryo-fetal development, without any mention of contraception. In contrast, U.S. can include women in the fertile clinical trials have not completed initial pre-clinical tests on the safety play, if they practice a pregnancy test before participation in contraception and take some action "highly effective". Are considered "highly effective" (by both the FDA and the EMEA, to be included in a document of the International Conference on Harmonization) methods with low failure rate (<1% per year) when used properly, such as implants, injectables, combined oral, some intrauterine devices (IUDs), sexual abstinence or a vasectomy for the partner. (excerpt)
Language: Spanish
Keywords:
SPAIN | RESEARCH REPORT | CLINICAL TRIALS | PREGNANCY TESTS | ORAL CONTRACEPTIVES, COMBINED | IUD | INJECTABLES | CONTRACEPTIVE IMPLANTS | VASECTOMY | Europe, Southwestern | Europe | Developed Countries | Clinical Research | Research Methodology | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Male Sterilization | Sterilization, Sexual
Document Number: 329576

15.

16.

17.

Peer Reviewed

Title: Profile of long-acting reversible contraception users in Europe.
Author: Haimovich S
Source: European Journal of Contraception and Reproductive Health Care. 2009 Jun;14(3):187-95.
Abstract: OBJECTIVES: To assess the profile of long-acting reversible contraceptives (LARCs) users in Europe. METHODS: A random sample of women aged 15-49 years in 14 European countries (Germany, France, UK, Spain, Italy, Russian Federation, Estonia, Latvia, Lithuania, Austria, Czech Republic, Denmark, Norway, and Sweden) underwent web-based or computer-aided face-to-face interviews in June 2006. In this paper data pertaining to a subgroup of women using LARCs are presented. RESULTS: A total of 11,490 women participated in the full study. Of these, 1,188 (10%) women were LARC (hormonal implant, injectables, levonorgestrel-releasing intrauterine system [LNG-IUS], copper intrauterine device [Cu-IUD]) users. The age of the LARC users exceeded 30 years for 57-91% of them. Furthermore, more than half of them found convenience an extremely important factor when selecting the LARC as a contraceptive method. As compared to those wearing a Cu-IUD, women using hormonal LARCs experienced fewer physical and emotional symptoms that appeared or worsened during menstruation. CONCLUSIONS: LARCs have their place in the contraceptive market in Europe. The most popular LARCs among European women were the LNG-IUS and the Cu-IUD; both were mainly used by women who had children and had no wish to have more in the future.
Language: English
Keywords:
EUROPE | RESEARCH REPORT | SAMPLING STUDIES | WOMEN | CONTRACEPTIVE USAGE | CONTRACEPTIVE IMPLANTS | INJECTABLES | IUD | CONTRACEPTIVE METHODS CHOSEN | AGE FACTORS | PARITY | SATISFACTION | CONTRACEPTIVE AGENTS, SIDE EFFECTS | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Contraceptive Methods | Population Characteristics | Fertility Measurements | Fertility | Population Dynamics | Psychological Factors | Behavior | Contraceptive Agents
Document Number: 341802

18.

19.
Title: The effects of hormonal contraception.
Author: Kent A
Source: Reviews In Obstetrics and Gynecology. 2009 Winter;2(1):66.
Abstract: There are many claims made about the beneficial effects of hormonal contraceptives other than their ability to prevent pregnancy. Studies have tracked women's responses to oral contraceptives (OCs) or depot medroxyprogesterone acetate (DMPA), but few have taken into account the woman's entry status or baseline symptoms, and fewer still have looked at control groups on nonhormonal contraception. Another problem has been the duration of follow-up, which should be longer than 1 year to properly assess the steady state of a changed hormonal environment. A study by Berenson and colleagues deals with the issues of baseline status and prolonged use in a series of women using injectable DMPA and low-dose OCs (typically 20 microg estrogen-containing pills). The first important finding was that symptoms are common in the absence of contraceptive use, such as acne, cyclical mastalgia, cramping, and mood swings. They found these symptoms improved on sustained use of OCs compared with control groups, and therewas no evidence that depression was a problem, despite lowered mood being a commonly quoted negative effect among those prescribing OCs. The most frequent side effect was intermenstrual bleeding with OCs and an increased risk of bleeding for more than 20 days, amenorrhea, weight gain, and loss of energy and libido on DMPA. Most of these effects resolved after 6 months and almost all resolved by 12 months, with amenorrheaic women often welcoming the side effect. Finally, the researchers found that women were not clearly informed of the potential side effects, or of their resolution with ongoing use. They recommend careful counseling about what to expect and more frequent follow-up after initiation to provide reassurance or a change to another method if required. (full-text)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | INJECTABLES | PSYCHOLOGICAL FACTORS | PHYSIOLOGY | CONTRACEPTIVE AGENTS, SIDE EFFECTS | DEPO-PROVERA | ORAL CONTRACEPTIVES, LOW-DOSE | CONTRACEPTIVE AGENTS, ESTROGEN | METRORRHAGIA | ADMINISTRATION AND DOSAGE | BREAST CANCER | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Economic Development | Economic Factors | Contraceptive Methods | Contraception | Family Planning | Behavior | Biology | Contraceptive Agents | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Oral Contraceptives | Bleeding | Signs and Symptoms | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms
Document Number: 331284

20.

Title: A review of the evidence developed for a technical consultation on expanding access to injectable contraception.
Author: Malarcher S
Source: [Research Triangle Park, North Carolina], Family Health International [FHI], 2009 Jun. 48 p.
Abstract: The document was prepared to facilitate deliberations for the Technical Consultation on Expanding Access to Injectable Contraceptives sponsored by the World Health Organization, the United States Agency for International Development, and Family Health International, scheduled to be held from 15-17 June 2009 in Geneva, Switzerland. This document summarizes the results of a literature review conducted to identify research evidence and program experience relevant to the objectives of the Technical Consultation: To review systematically the evidence and programmatic experience on interventions designed to expand access to / provision of contraceptive injectables, focusing on non clinic-based services and programs; To reach conclusions on issues: (a) for which evidence is consistent and strong; (b) for which evidence is mixed; and (c) for which evidence is marginal or entirely lacking and, thus requires additional research; To document discussions and conclusions of the Consultation, including policy and program implications, and to disseminate these widely. Use of community-based injectable services was significant in all studies reviewed. This evidence suggests that community-based delivery of injectable services by CHW is acceptable in a wide variety of settings. (Excerpts)
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | WHO | INJECTABLES | DEPO-PROVERA | NEEDS | SAFETY | CONTRACEPTIVE USAGE | PROGRAM ACCESSIBILITY | CONTRACEPTION CONTINUATION | CONTRACEPTIVE AGENTS, SIDE EFFECTS | TRAINING ACTIVITIES | COUNSELING | MONITORING | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Economic Factors | Public Health | Health | Program Evaluation | Programs | Organization and Administration | Training Programs | Education | Clinic Activities | Program Activities | Evaluation
Document Number: 331835

21.

Peer Reviewed

Title: Trials for development of once-a-month injectable, hormonal male contraceptive using dienogest plus testosterone undecanoate: dose standardization, efficacy and reversibility studies in rats.
Author: Misro MM; Chaki SP; Kaushik MC; Nandan D
Source: Contraception. 2009 Jun;79(6):488-97.
Abstract: BACKGROUND: The study was conducted to test the potential of using dienogest (DNG) plus testosterone undecanoate (TU) in rats for development of a once-a-month injectable male hormonal contraceptive. STUDY DESIGN: Dose selection studies were initiated with administration of DNG in three different doses of 20, 30 and 40 mg/kg body weight (bw) per week plus TU 25 mg/kg bw once in every 6 weeks. Status of spermatogenesis and sperm count in epididymis was evaluated. The frequency of DNG intervention was later extended to every 2- and 4-week intervals. Mating studies, toxicity and reversibility of spermatogenesis following stoppage of treatment were carried out with DNG 40 mg/kg bw at 4-week intervals. RESULTS: Complete arrest of spermatogenesis was observed after 60 days of treatment at all doses of DNG (20, 30 and 40 mg/kg bw per week)+TU. However, weights of testis and accessory sex organs (epididymis, prostate and seminal vesicle) declined significantly 60 days post treatment compared to vehicle-treated controls. Epididymis in the treated animals was completely devoid of sperm. When the frequency of DNG injection (20 mg/kg bw) was extended to once every 15 days, a few immotile and decapitated sperm were observed in the epididymis. With TU treatment unchanged, animals receiving DNG (40 mg/kg bw) once either every 2- or 4-week intervals demonstrated good and uniform arrest of spermatogenesis. DNG 40 mg/kg per 4 weeks+TU also demonstrated a significant rise in germ cell apoptosis in the seminiferous epithelium. There was no significant increase in the serum high-density lipoprotein and low-density lipoprotein levels at the end of 120 days of treatment. Following withdrawal of treatment after 60 or 120 days, qualitative restoration of spermatogenesis was rapid in the former compared to the latter. CONCLUSION: Dienogest plus TU has the potential for development as a monthly injectable showing reversible hormonal male contraception with good efficacy.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | LABORATORY ANIMALS | MEN | INJECTABLES | TESTOSTERONE | ADMINISTRATION AND DOSAGE | STANDARDIZATION | REVERSIBLE STERILIZATION | MALE CONTRACEPTION | BODY WEIGHT | TIME FACTORS | SPERMICIDAL CONTRACEPTIVE AGENTS | Asia, Southern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Androgens | Hormones | Endocrine System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Data Adjustment | Sterilization, Sexual | Population Dynamics | Contraceptive Agents
Document Number: 341101

22.

Title: Comparative performance of a combined injectable contraceptive (50 mg norethisterone enanthate plus 5mg estradiol valerate) and a combined oral contraceptive (0.15 mg levonorgestrel plus 0.03 mg ethinyl estradiol) in adolescents.
Author: Molina RC; Sandoval JZ; Montero AV; Oyarzun PG; Molina TG; Gonzalez EA
Source: Journal of Pediatric and Adolescent Gynecology. 2009 Feb;22(1):25-31.
Abstract: STUDY OBJECTIVE: To compare in a regular non-clinical trial experience the efficacy, acceptability, and continuation rates of an injectable contraceptive containing 50 mg norethisterone enanthate plus 5mg estradiol valerate (IC) and an oral contraceptive containing 0.15 mg levonorgestrel plus 0.03 mg ethinyl estradiol (OC), among adolescent users. DESIGN: A total of 251 adolescents ages 14-19 were followed during 12 months. The IC group (124 subjects) was studied for 1044 cycles and the OC group (127 subjects) was studied for 1368 cycles. The users were not assigned in a random selection. Information was collected from clinical records. Groups were compared using Pearson chi-square, odds ratio (95% confidence interval), t-test, and proportion difference test. RESULTS: The IC group had significant differences in baseline social risk, confidence, psychiatric problems, consumption of alcohol, and number of sexual partners. At 12 months, the IC group showed significant decrease in weight and increase in hypermenorrhea. In the OC group, dysmenorrhea decreased, and hypomenorrhea and regular cycles were significantly more frequent. One pregnancy occurred in the OC group (Pearl Index: 0.88). Final continuation rates at 12 months were 41.9% and 37.8% for IC and OC, respectively. CONCLUSIONS: The monthly injectable is a recommended contraceptive option for adolescents, especially for those facing psychosocial risk factors.
Language: English
Keywords:
CHILE | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | ADOLESCENTS, FEMALE | INJECTABLES | NORETHINDRONE ENANTHATE | ORAL CONTRACEPTIVES, COMBINED | LEVONORGESTREL | ETHINYL ESTRADIOL | ADMINISTRATION AND DOSAGE | TIME FACTORS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | Developing Countries | South America, Southern | South America | Latin America | Americas | Research Methodology | Studies | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Norethindrone | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Oral Contraceptives | Contraceptive Agents, Estrogen | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Safety | Public Health
Document Number: 330349

23.

Title: Formulation and Performance Characterization of Radio-Sterilized "Progestin-Only" Microparticles Intended for Contraception.
Author: Puthli S; Vavia P
Source: AAPS PharmSciTech. 2009 Apr 21;
Abstract: The aim of this study was to formulate and characterize a microparticulate system of progestin-only contraceptive. Another objective was to evaluate the effect of gamma radio-sterilization on in vitro and in vivo drug release characteristics. Levonorgestrel (LNG) microspheres were fabricated using poly(lactide-co-glycolide) (PLGA) by a novel solvent evaporation technique. The formulation was optimized for drug/polymer ratio, emulsifier concentration, and process variables like speed of agitation and evaporation method. The drug to polymer ratio of 1:5 gave the optimum encapsulation efficiency. Speed of agitation influenced the spherical shape of the microparticles, lower speeds yielding less spherical particles. The speed did not have a significant influence on the drug payloads. A combination of stabilizers viz. methyl cellulose and poly vinyl alcohol with in-water solvent evaporation technique yielded microparticles without any free drug crystals on the surface. This aspect significantly eliminated the in vitro dissolution "burst effect". The residual solvent content was well within the regulatory limits. The microparticles passed the test for sterility and absence of pyrogens. In vitro dissolution conducted on the product before and after gamma radiation sterilization at 2.5 Mrad indicated no significant difference in the drug release patterns. The drug release followed zero-order kinetics in both static and agitation conditions of dissolution testing. The in vivo studies conducted in rabbits exhibited LNG release up to 1 month duration with drug levels maintained within the effective therapeutic window.
Language: English
Keywords:
INDIA | RESEARCH REPORT | EVALUATION | WOMEN | CONTRACEPTIVE AGENTS, PROGESTIN | ANALYSIS | FEMALE STERILIZATION | LEVONORGESTREL | LABORATORY PROCEDURES | INJECTABLES | Asia, Southern | Asia | Developing Countries | Demographic Factors | Population | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Research Methodology | Sterilization, Sexual | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods
Document Number: 331124

24.

Title: Fabrication, characterization and in vivo studies of biodegradable gamma sterilized injectable microparticles for contraception.
Author: Puthli SP; Vavia PR
Source: Pharmaceutical Development and Technology. 2009 Feb 23;:1-7.
Abstract: A Levonorgestrel-loaded microparticulate system was developed with gelatin and bovine serum albumin using triple emulsion technique coupled with chemical cross-linking thermal rigidization method. The formulation was optimized for various formulation variables and process parameters. The microparticulate system was characterized by scanning electron microscopy, encapsulation efficiency, moisture content, IR, DSC, XRD, residual solvent content and evaluated for sterility, abnormal toxicity and absence of pyrogens. Microparticles were sterilized by gamma irradiation at 2.5 Mrad. The system was injected intramuscularly in rabbits and drug blood levels estimated using radioimmunoassay technique. An optimized drug to polymer ratio of 0.4:0.75 w/w gave drug encapsulation efficiency of about 40%. The in vitro drug release followed Higuchi square root kinetics. In in vivo studies the AUC0-t was found to be 12849.25 pg/mL.day(-1) with mean residence time calculated to be about 16 days and Kel of 0.02 day(-1). Levonorgestrel (LNG) levels were maintained between 200 and 400 pg/mL. The pharmacokinetic results indicate that LNG is released from the injectable microparticles for a period of one-month duration.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CONTRACEPTION RESEARCH | LEVONORGESTREL | INJECTABLES | IN VITRO | LABORATORY PROCEDURES | Asia, Southern | Asia | Developing Countries | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Methods | Clinical Research | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330419

25.

Title: New technologies in contraception.
Author: Rowlands S
Source: BJOG. 2009 Jan;116(2):230-9.
Abstract: New technologies in both reversible contraception and sterilisation are described. The review includes recent advances in the development of oral contraception, emergency contraception, injectable contraception, vaginal rings, subdermal implants, transdermal contraception, intrauterine devices, spermicides and barrier methods. It also covers methods of transcervical female sterilisation and more easily reversible male sterilisation. The emphasis is on the technology and its safety and effectiveness. Hormonal delivery systems are described in some detail. Mention is also made of research into vaccines and male hormonal methods, where progress has been disappointing.
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | CLINICAL RESEARCH | TARGET POPULATION | CONTRACEPTION | STERILIZATION, SEXUAL | REVERSIBLE STERILIZATION | EMERGENCY CONTRACEPTION | IUD | VAGINAL RING | INJECTABLES | SPERMICIDAL CONTRACEPTIVE AGENTS | BARRIER METHODS | CERVIX | SAFETY | Research Methodology | Program Design | Programs | Organization and Administration | Family Planning | Contraceptive Methods | Contraceptive Agents | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Public Health | Health
Document Number: 330720

26.

Title: Polyelectrolyte polymer properties in relation to male contraceptive RISUG action.
Author: Roy S; Ghosh D; Guha SK
Source: Colloids and Surfaces. B, Biointerfaces. 2009 Feb 15;69(1):77-84.
Abstract: RISUG a polyelectrolytic hydrogel (styrene maleic anhydride and dimethyl sulfoxide) has proven to be efficacious as a contraceptive for a long term when injected into the lumen of vas deferens. Currently it is in advanced phase III clinical trials in India. Present investigation analyzes the swelling characteristics of RISUG hydrogel in different pH buffers and various biological fluids to understand its retention in the vas deferens as reported in previous studies. Significant variation in degree of swelling and equilibrium swelling ratio with transformation of Fickian to non-Fickian mode of diffusion was observed with increased pH. This might be due to ionization of carboxylic groups at high pH resulting in increased electrostatic repulsive force and high osmotic pressure inside the hydrogel network affecting its physical cross-linking and increases the free volume. Conversely, at low pH the dissociation of carboxylic group is limited making the hydrogel more stable. Interaction with various biomolecules present in various biological fluids was also studied. SEM, AFM and FTIR were used to analyze the topological and structural parameters of the polymer in different mediums. Loosening of structure and increasing porosity with significant adsorption of various biomolecules was observed. AFM revealed a significant change in overall roughness of polymer surface on interaction with different biological fluids. These observations suggest that the swelling and increased roughness will lead to increased resistance to sperm movement in the vas deferens.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL TRIALS | MEN | CONTRACEPTIVE AGENTS, MALE | LONGTERM EFFECTS | INJECTABLES | SPERM IMMOBILIZING AGENTS | Asia, Southern | Asia | Developing Countries | Clinical Research | Research Methodology | Demographic Factors | Population | Contraceptive Agents | Contraception | Family Planning | Time Factors | Population Dynamics | Contraceptive Methods | Spermicidal Contraceptive Agents
Document Number: 330994

27.
Title: Long-acting reversible contraception: reducing unintended pregnancies.
Author: Ruddick C
Source: Community Practitioner. 2009 Sep;82(9):24-7.
Abstract: This paper gives a brief history of the development of contraception and looks at the methods available in the U.K., with particular emphasis on National Institute for Health and Clinical Excellence guidance about long-acting reversible contraception--injections, implants and intrauterine methods. These methods have the potential to reduce unintended pregnancies, but at present remain underused. Providing positive messages about their ease of use and reversibility, and describing them as 'lasting' rather than 'long-acting' may increase their acceptability.
Language: English
Keywords:
UNITED KINGDOM | SUMMARY REPORT | PREGNANCY, UNPLANNED | INJECTABLES | CONTRACEPTIVE IMPLANTS | IUD | CONTRACEPTIVE MODE OF ACTION | KNOWLEDGE | PRIMARY HEALTH CARE | CONTRACEPTIVE METHOD ACCEPTABILITY | COST EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Sociocultural Factors | Health Services | Delivery of Health Care | Health | Contraceptive Usage | Evaluation Indexes | Quantitative Evaluation | Evaluation
Document Number: 342927

28.

Peer Reviewed

Title: Nurse auxiliaries as providers of intrauterine devices for contraception in Guatemala and Honduras.
Author: Vernon R
Source: Reproductive Health Matters. 2009 May;17(33):51-60.
Abstract: Nurse auxiliaries staff the majority of primary health service delivery outlets in low-income countries, particularly in rural areas with high unmet need for contraception. Yet often service delivery guidelines prohibit them from providing contraceptive methods such as the intrauterine device (IUD). Operations research in Guatemala and Honduras in 1997-2005, described in this paper, have shown that nurse auxiliaries can provide IUDs in a safe and clinically appropriate fashion, which can help improve women's choice of methods and decrease costs in health centres with physicians and professional nurses, and health posts. Empowering these health workers requires commitment at the health system and policy levels to a long-term strategy in which small pilot studies are first conducted, followed by phased scaling-up of the strategies, which can require several years. Training can be conducted both in high volume clinics or on-site in health posts. Simple measures such as mentioning the method during counselling and to users of different services and providing women and communities with printed materials have been effective in increasing requests for IUDs. These studies also showed that nurse auxiliaries can take on other reproductive health services, such as contraceptive injections.
Language: English
Keywords:
GUATEMALA | HONDURAS | CRITIQUE | OPERATIONS RESEARCH | PARAMEDICAL PERSONNEL | IUD | INJECTABLES | TRAINING PROGRAMS | NEEDS | COST EFFECTIVENESS | Central America | Latin America | Americas | Developing Countries | Research Methodology | Program Evaluation | Programs | Organization and Administration | Health Personnel | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Education | Economic Factors | Evaluation Indexes | Quantitative Evaluation | Evaluation
Document Number: 341668

29.

Peer Reviewed

Title: Young women's continued use of oral contraceptives over other hormonal methods: findings from a qualitative study.
Author: Williamson LM; Buston K; Sweeting H
Source: Journal of Family Planning and Reproductive Health Care. 2009 Jul;35(3):167-72.
Abstract: BACKGROUND: Long-acting reversible contraceptives (LARC) have become more commonly promoted in the UK, but most young women still rely on the contraceptive pill. Here, we describe young women's accounts of hormonal contraceptive use to explore why this might be the case. METHODS: In-depth interviews with twenty 20-year-old women from eastern Scotland in the UK. RESULTS: All but one woman reported use of the pill. It was the method they expected to use, sought out, and received. Belief in the pill's efficacy was maintained even when knowledge or experience of failure suggested otherwise. Only four women reported using alternative hormonal methods and only did so after experiencing unmanageable problems with the pill (side effects or forgetting to take it). All then discontinued use because of weight gain or dislike of menstrual suppression. CONCLUSIONS: Attempts to promote LARC must address these issues. Pill use can be unproblematic if managed well, and should continue to be promoted as an appropriate contraceptive for young women.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | QUALITATIVE RESEARCH | YOUTH | WOMEN | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, SIDE EFFECTS | INJECTABLES | CONTRACEPTIVE METHODS CHOSEN | CONTRACEPTIVE METHOD SWITCHING | INTERVIEWS | Developed Countries | Europe, Western | Europe | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Usage | Data Collection
Document Number: 342137

30.

Peer Reviewed

Title: ACOG Committee Opinion No. 415: Depot medroxyprogesterone acetate and bone effects.
Author: American College of Obstetricians and Gynecologists Committee on
Source: Obstetrics and Gynecology. 2008 Sep;112(3):727-30.
Abstract: Although depot medroxyprogesterone acetate (DMPA) is associated with bone mineral density (BMD) loss during use, current evidence suggests that partial or full recovery of BMD occurs at the spine and at least partial recovery occurs at the hip after discontinuation of DMPA. Given the efficacy of DMPA, particularly for populations such as adolescents for whom contraceptive adherence can be challenging or for those who feel they could not comply with a daily contraceptive method or a method that must be used with each act of intercourse, the possible adverse effects of DMPA must be balanced against the significant personal and public health impact of unintended pregnancy. Concerns regarding the effect of DMPA on BMD should neither prevent practitioners from prescribing DMPA nor limit its use to 2 consecutive years. Practitioners should not perform BMD monitoring solely in response to DMPA use because any observed short-term loss in BMD associated with DMPA use may be recovered and is unlikely to place a woman at risk of fracture during use or in later years.
Language: English
Keywords:
UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN | SKELETAL EFFECTS | MEDROXYPROGESTERONE ACETATE | INJECTABLES | CONTRACEPTIVE AGENTS, SIDE EFFECTS | TIME FACTORS | MONITORING | OSTEOPOROSIS | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Population Dynamics | Evaluation
Document Number: 329049


	Information & Knowledge for Optimal Health (INFO) Project 111 Market Place Suite 310, Baltimore, MD 21202 Phone: 410-659-6300 Fax: 410-659-6266 Security & Privacy Policy